Gov. Rick Scott spoke before the Forum Club of the Palm Beaches Monday.

February 20, 2013|By Kathleen Hughes and William E. Gibson

TALLAHASSEE Gov. Rick Scott announced Wednesday a proposed three-year expansion of Florida's Medicaid program — enrolling an additional one million poor and disabled Floridians beginning next year — after the Obama administration gave the state tentative approval to privatize Medicaid services.

If the Legislature approves, Scott's announcement means the state will extend eligibility in the federal-state program to single people and families earning up to 138 percent of poverty. The state would enroll almost all of them, along with the 3.3 million people currently being served by Medicaid, in private HMOs or other doctor-operated networks.

"While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care," Scott said at a press conference. He added that the expansion would have to be renewed in three years.

The announcement was a major switch for Scott, a former health care executive, who was adamantly opposed to the Affordable Care Act and used it as the centerpiece of his 2010 gubernatorial bid.

Under the Affordable Care Act, or Obamacare, the federal government has promised to pay the total cost of expanding Medicaid rolls for three years. After that, the state's share would gradually increase to 10 percent of the cost by 2020 and beyond. The state pays just 58 percent of the cost of current Medicaid recipients.

Florida has about 3.8 million uninsured residents total, but only about 1 million would qualify for the Medicaid expansion. Scott's office had previously estimated the expansion would cost Florida about $5 billion over the next 10 years.

Scott's decision follows similar choices by Republican governors in Arizona, Michigan, New Mexico, North Dakota, Ohio and Nevada. It reflects the easing of GOP opposition to Obamacare since President Barack Obama's re-election.

Scott, with a nod to Tea Party and conservative Republican opposition, called the expansion " a compassionate, common sense step forward…."And," he added in prepared remarks, "it is not a white flag of surrender to government-run healthcare."

But Scott's decision may be challenged by the Florida Legislature, which has named committees to explore the cost of the proposal.

"Governor Scott has made his decision and I certainly respect his thoughts," said House Speaker Will Weatherford, R-Wesley Chapel, in a statement. "However, the Florida Legislature will make the ultimate decision. I am personally skeptical that this inflexible law will improve the quality of healthcare in our state and ensure our long-term financial stability."

And Senate President Don Gaetz, R-Niceville, was noncommittal, saying he was "eager" to see recommendations of the Senate committee studying the expansion and "look[s] forward to working with our partners in the House and with Governor Scott on the right solution for Florida."

And one conservative group was quick to pronounce itself "extremely disappointed…For far too long, states have fallen for the promises of 'free' federal money ignoring the insidious federal strings and the long-term effects on state budgets," said Slade O'Brien of Americans for Prosperity/Florida, adding, "Hopefully our legislative leaders will not follow in Governor Scott's footsteps and will reject expansion of this broken system."

But health-care advocates were jubilant.

"This is truly a hallelujah moment for working families throughout the state, and it augurs well for other Republican governors making the same decision for their states," said Ron Pollack, executive director of Families USA.

Scott's announcement came a few hours after the Centers for Medicare and Medicaid Services announced its tentative approval of a managed-care plan that Scott had previously said might well determine his decision on expansion – though the governor said he had not committed to the expansion in return for the approval.

The nod comes nearly two years after the state passed a law to totally revamp the $21-billion Medicaid program from a fee-for-service model to 11 districts in which private HMO's or physician networks would enroll recipients. Only the roughly 30,000 Medicaid recipients with a developmental disability would be exempt and instead served by a plan tailored to their individual needs.

But, the approval is conditional.

According to CMS, the state still needs to show how it plans to monitor the quality of care that the Medicaid recipients will receive, plus create a "rigorous and independent evaluation" of the managed-care plans.